5
English
Quarter 1 – Module 1
Filling out Forms Accurately
(school forms, deposit slips, and
withdrawal slips)
CO_Q1_English5_Module1
English – Grade 5
Alternative Delivery Mode
Quarter 1 – Module 1: Filling out Forms Accurately (school forms, deposit slips and
withdrawal slips)
First Edition, 2020
Republic Act 8293, Section 176 states that: No copyright shall subsist in any work of
the Government of the Philippines. However, prior approval of the government agency or office
wherein the work is created shall be necessary for exploitation of such work for profit. Such
agency or office may, among other things, impose as a condition the payment of royalties.
Borrowed materials (i.e., songs, stories, poems, pictures, photos, brand names,
trademarks, etc.) included in this module are owned by their respective copyright holders.
Every effort has been exerted to locate and seek permission to use these materials from their
respective copyright owners. The publisher and authors do not represent nor claim ownership
over them.
Published by the Department of Education
Secretary: Leonor Magtolis Briones
Undersecretary: Diosdado M. San Antonio
Development Team of the Module
Writer:
Reymarc Jonvil F. Dacallos
Editors:
Rustum D. Geonzon, Ferdinand A. Negros, and Dean Ric M. Endriano
Reviewers:
Josefina F. Dacallos, Dina S. Superable, and Cynthia Agner
Layout Artists: Janssen Louel C. Dabuet and Gibson J. Gayda
Management Team:
Ramir B. Uytico
Arnulfo M. Balane
Rosemarie M. Guino
Joy B. Bihag
Ryan R. Tiu
Dean Ric M. Endriano
Teodorico C. Peliño Jr.
Carmela R. Tamayo
Moises D. Labian Jr.
Antonio F. Caveiro
Josefina F. Dacallos
Faustino M. Tobes
Rustum D. Geonzon
Printed in the Philippines by ________________________
Department of Education – Region VIII
Office Address:
Government Center, Candahug, Palo, Leyte
Telefax:
053 – 832-2997
E-mail Address:
region8@deped.gov.ph
5
English
Quarter 1 – Module 1
Filling out Forms Accurately
(school forms, deposit slips, and
withdrawal slips)
Introductory Message
This Self-Learning Module (SLM) is prepared so that you can continue your
studies and learn while at home. Activities, questions, directions, exercises, and
discussions are carefully stated for you to understand each lesson.
Each SLM is composed of different parts. Each part shall guide you step-by
step as you discover and understand the lesson prepared for you.
Pre-tests are provided to measure your prior knowledge on lessons in each
SLM. These will tell you if you need to proceed on completing this module or if you
need to ask your facilitator or your teacher’s assistance for better understanding of
the lesson. At the end of each module, you need to answer the post-test to selfcheck your learning. Answer keys are provided for each activity and test. We trust
that you will be honest in using these.
In addition to the material in the main text, Notes to the Teacher is also
provided to our facilitators and parents for strategies and reminders on how they
can best help you in home-based learning.
Please use this module with care. Do not put unnecessary marks on any
part of this SLM. Use a separate sheet of paper in answering the exercises and tests
and read the instructions carefully before performing each task.
If you have any questions in using this SLM or any difficulty in answering
the tasks in this module, do not hesitate to consult your teacher or facilitator.
Good luck and happy learning!
ii
What I Need to Know
We are oftentimes asked to fill out forms whenever we use documents at the
school, bank, or office. This is an essential activity that we cannot avoid doing. For
these reasons, we need to master how to fill out forms. Can you do the job?
Did you know that to fill up CANNOT be used to mean the act of completing a
form? Can a form hold liquid? Since it cannot, it is not appropriate to use fill up. The
appropriate expressions are fill in and fill out. So, please don’t ask anyone to fill
up a form because they will not be able to do it. Ask them to fill in or fill out a form
instead.
So, fill out now. Remember to always be accurate.
In this module, you will be able to:
•
•
fill out forms accurately and
appreciate the importance of filling out forms accurately
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CO_Q1_English5_Module1
What I Know
Directions: Fill out the form below. Complete it by using the possible answers
found inside the box. Use the form provided to you.
Student Personal Information
Name: ____________________________________________________________
Grade & Section: ___________________Age: _____ Sex: _______________
Teacher: __________________________________________________________
Address: __________________________________________________________
Birthday: __________________________ Country: _____________________
School: ___________________________________________________________
Royce L. Cabrera
Male
Ms. Rina B. Macaraig
Grade V- Maagap
Catbalogan City, Samar
December 25, 2010
San Roque Elementary School
Philippines
2
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CO_Q1_English5_Module1
What’s In
Directions: Examine the forms below and then identify each. Pick your answer
from the choices inside the box. Write it on your answer sheet.
cash deposit slip
school form
withdrawal slip
1.
2.
3.
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CO_Q1_English5_Module1
What’s New
Thinking Beyond
Directions: Examine closely the completed (filled out) forms and the required
information that was supplied in each form. Using a Venn diagram, write down the
similarities and differences of the forms based on the required information in filling
it out. Do this on your answer sheet.
CASH DEPOSIT
SLIP
Write here the
required
information found
on the cash
deposit slip.
Write here the
required
information
found on both
the cash deposit
and withdrawal
slips.
4
WITHDRAWAL
SLIP
Write here the
required
information found
on the withdrawal
slip.
CO_Q1_English5_Module1
What Is It
A deposit slip is a small paper form that a person includes with a bank
deposit to show how much money he or she is putting in a bank account. It contains
the deposit date, name and bank account number of the depositor, and the amount
to be deposited in the form of checks or cash, and the signature of the depositor.
Specifically, a person who deposits or places money in a bank account is called
a depositor.
How to Fill out a Deposit Slip
1. First, write your name and bank account number.
2. Then, supply additional details, such as transaction date and any branch
information required.
3. List the cash amount breakdown of your deposit and the total amount
thereafter.
4. Affix your signature over printed name found on the lower part of the form.
5
CO_Q1_English5_Module1
On the other hand, a withdrawal slip is a small paper form which has to be
filled out before making a withdrawal of money from a bank. After filling out the bank
slip, a person signs on it in the presence of a bank teller. A bank teller is an employee
of the bank whose job is to help bank customers with their banking needs, such as
depositing checks or cash or making a withdrawal.
How to Fill out a Withdrawal Slip
1. First, write your name and the date.
2. Then, write the desired amount of your withdrawal in words and in figures.
3. Finally, affix your signature on the signature line found on the form, but do
this only until a bank teller can witness you signing it.
This time let us try to go through a very common form that you usually
accomplish every school year. Are you familiar with this form?
6
CO_Q1_English5_Module1
ANNEX 1
MODIFIED BASIC EDUCATION ENROLLMENT FORM
THIS FORM IS NOT FOR SALE.
Check the appropriate box only:
-
School Year:
No LRN
Grade level to Enroll:
INSTRUCTIONS:
With LRN
Returning (Balik-Aral)
Print legibly all information required in CAPITAL letters. Submit accomplished form to the
Person-in-Charge/Registrar/Class Adviser. Use black or blue pen only.
STUDENT INFORMATION
PSA Birth Certificate No. (if available upon registration)
Learner Reference No. (LRN)
LAST NAME
FIRST NAME
MIDDLE NAME
EXTENSION NAME e.g. Jr., III (if applicable)
DATE OF BIRTH
(Month/Day/Year)
/
/
Belonging to any Indigenous Peoples (IP)
Community/Indigenous Cultural Community?
SEX
No
Yes
MALE
FEMALE
AGE
If Yes, please specify:
Mother Tongue
ADDRESS
House Number and Street
Barangay
City/Municipality/Province/Country
Zip Code
PARENT’S/GUARDIAN’S INFORMATION
Father’s Name (Last Name, First Name, Middle Name)
Mother’s Maiden Name (Last Name, First Name, Middle Name)
Guardian’s Name (Last Name, First Name, Middle Name)
Telephone No.
Cellphone No.
For Returning Learners (Balik-Aral) and Those Who Shall Transfer/Move In
Last Grade Level Completed
Last School Year Completed
School ID
School Name
School Address
For Learners in Senior High School
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CO_Q1_English5_Module1
Semester
2nd Sem
1st Sem
Track
Strand (if any)
Preferred Distance Learning Modality/ies
Modular (Print)
Online
Radio-based instruction
Modular (Digital)
Educational TV
Homeschooling
Blended
I hereby certify that the above information given are true and correct to the best of my
knowledge and I allow the Department of Education to use my child’s details to create and/or update
his/her learner profile in the Learner Information System. The information herein shall be treated as
confidential in compliance with the Data Privacy Act of 2012.
Signature Over Printed Name of Parent/Guardian
Date
Notice that this form uses boxes to be accomplished with specific instructions.
Let’s do this!
The first field asks for the school year. There are 8 boxes separated with a
dash (-) in between four boxes. This means you are to put the numerical
representation of the school year you are enrolling in.
Ex. 2020-2021
On the upper right corner of this form, you will notice the instruction “Check the
appropriate box only:”
Here you will put a check mark only on the field that is true to your situation.
Ex. (check on the with LRN)
Pay attention to the main instruction reflected on this form. There are fields that
require you to write in capital letters. For example:
LAST NAME (please play out the boxes) DE LA CRUZ
FIRST NAME
JUAN
MIDDLE NAME
GARCIA
EXTENSION NAME
JR.
Further, under the date of birth, boxes where you can place your birth details
appear. Sometimes, these bits of information use a pattern like this:
MM-DD-YYYY
This means, you are going to put the numerical representation of the month of
birth. For example, January will be reflected as 01, the day of your birth falling on
8
CO_Q1_English5_Module1
the 28th of January will show 28; and lastly, the year of your birth is written in full
as 1978. Therefore, you will accomplish this field following this example:
Example:
DATE OF BIRTH
0
(Month/Day/Year)
1
/
2
8
/
1
9
7
8
Let us give emphasis on ticking boxes appropriately, writing CAPITAL
LETTERS when required, placing name extensions, and representing information in
numerical form.
Example:
ANNEX 1
MODIFIED BASIC EDUCATION ENROLLMENT FORM
THIS FORM IS NOT FOR SALE.
Check the appropriate box only:
-
School Year:
2 0 2 0
2 0 2 1
No LRN
/
With LRN
Grade level to Enroll:
V
INSTRUCTIONS:
Print legibly all information required in CAPITAL letters. Submit accomplished form to the
Person-in-Charge/Registrar/Class Adviser. Use black or blue pen only.
Returning (Balik-Aral)
STUDENT INFORMATION
PSA Birth Certificate No. (if available upon registration)
Learner Reference No. (LRN)
5
0
1
LAST NAME
D
E
L
A
FIRST NAME
J
U
A
N
MIDDLE NAME
G A
R
C
9
I
1
8
1
2
3
4
C
R
U
Z
8
SEX
/
Yes
If Yes, please specify:
A
EXTENSION NAME e.g. Jr., III (if applicable)
DATE OF BIRTH
(Month/Day/Year)
0
1
/
2
8
/
Belonging to any Indigenous Peoples (IP)
Community/Indigenous Cultural Community?
Mother Tongue
1
/
9
7
No
MALE
FEMALE
AGE
43
7
2
Waray
ADDRESS
House Number and Street
Real Street
Barangay
Poblacion 01
City/Municipality/Province/Country
Zip Code
Daram, Samar
6
2
PARENT’S/GUARDIAN’S INFORMATION
Father’s Name (Last Name, First Name, Middle Name)
Mother’s Maiden Name (Last Name, First Name, Middle Name)
DELA CRUZ, RICARDO MENDOZA
GARCIA, JOSEFA SILANG
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CO_Q1_English5_Module1
DELA CRUZ, RICARDO MENDOZA
Guardian’s Name (Last Name, First Name, Middle Name)
Telephone No.
Cellphone No.
09105954692
For Returning Learners (Balik-Aral) and Those Who Shall Transfer/Move In
Last Grade Level Completed
Last School Year Completed
School ID
School Name
School Address
Semester
1st Sem
For Learners in Senior High School
2nd Sem
Track
Strand (if any)
Preferred Distance Learning Modality/ies
/
Modular (Print)
Online
Radio-based instruction
Modular (Digital)
Educational TV
Homeschooling
Blended
I hereby certify that the above information given are true and correct to the best of my
knowledge and I allow the Department of Education to use my child’s details to create and/or update
his/her learner profile in the Learner Information System. The information herein shall be treated as
confidential in compliance with the Data Privacy Act of 2012.
RICARDO M. DELA CRUZ
07-10-2021
Signature Over Printed Name of Parent/Guardian
Date
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CO_Q1_English5_Module1
What’s More
Directions: Fill out a withdrawal slip using the suggested information found in the
box. Use the form provided to you.
•
•
•
•
•
11
July 1, 2020
1234567891
Criselda V. Castillo
Ten Thousand
Pesos
P 10,000.00
CO_Q1_English5_Module1
What I Have Learned
To fill out a form is to complete a form by writing the required information
on it.
There are two forms that bank customers use to address their banking needs.
One is a deposit slip which is a small paper form that a bank customer includes
with a bank deposit to show how much money he or she is putting in a bank account.
Another is a withdrawal slip which is a small paper form that has to be filled out
before making a withdrawal of money from a bank.
Moreover, a depositor is a person who deposits or places money in a bank
account, whereas a bank teller is an employee of the bank whose job is to help bank
customers with their banking needs, such as depositing checks or cash or making a
withdrawal.
Additionally, a school enrolment form is a school document that shows
information about a learner or student who enrolls in a specific school. This form
also contains the learner’s profile that includes details on where he or she lives and
the learner’s current school records such as class and grade level to cite some
examples.
As a whole, there are particular forms that you have to fill out as a
requirement for admission to a school or when transacting in a bank. Accuracy is
very important in filling out these forms.
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CO_Q1_English5_Module1
What I Can Do
Helping a Friend
Directions: Read the selection about Ana and her Grandma. Help your friend, Ana,
by completing the withdrawal slip for her grandma. Use the form provided to you.
Off to the Bank
Hi, my name is Ana. I will accompany my Grandma to the
bank today. Grandma told me that we have to drop by the bank
before going to the mall to buy me a birthday present. Today is
May 28, 2020 and two days from now I will be turning 10!
Grandma needs money for the birthday present. Today,
she will get 3,000 pesos from her bank account. She will have to
complete a form and she calls it a withdrawal slip. Can you help
Grandma complete the form, so that we can have the money for
my birthday present? Yehey! Thank you.
Don’t forget to leave the depositor’s signature line empty,
so that Grandma can sign it.
Here’s Grandma’s bank information.
Name
Account Number
13
: Linda Cruz
: 0977 4444 88
CO_Q1_English5_Module1
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CO_Q1_English5_Module1
Assessment
Directions: You have a savings bank account and you want to put an amount of
2, 000 pesos into it, with the following cash breakdown: two five hundred-peso bills
and ten one hundred-peso bills. Using the bank account number 0344- 5555- 22,
complete a cash deposit slip. Fill out the form provided to you.
15
CO_Q1_English5_Module1
Additional Activities
Directions: Complete the school form shown below. Use the form provided to you.
ANNEX 1
MODIFIED BASIC EDUCATION ENROLLMENT FORM
THIS FORM IS NOT FOR SALE.
Check the appropriate box only:
-
School Year:
No LRN
Grade level to Enroll:
INSTRUCTIONS:
With LRN
Returning (Balik-Aral)
Print legibly all information required in CAPITAL letters. Submit accomplished form to the
Person-in-Charge/Registrar/Class Adviser. Use black or blue pen only.
STUDENT INFORMATION
PSA Birth Certificate No. (if available upon registration)
Learner Reference No. (LRN)
LAST NAME
FIRST NAME
MIDDLE NAME
EXTENSION NAME e.g. Jr., III (if applicable)
DATE OF BIRTH
(Month/Day/Year)
/
/
Belonging to any Indigenous Peoples (IP)
Community/Indigenous Cultural Community?
SEX
No
Yes
MALE
FEMALE
AGE
If Yes, please specify:
Mother Tongue
ADDRESS
House Number and Street
Barangay
City/Municipality/Province/Country
Zip Code
PARENT’S/GUARDIAN’S INFORMATION
Father’s Name (Last Name, First Name, Middle Name)
Mother’s Maiden Name (Last Name, First Name, Middle Name)
Guardian’s Name (Last Name, First Name, Middle Name)
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CO_Q1_English5_Module1
Telephone No.
Cellphone No.
For Returning Learners (Balik-Aral) and Those Who Shall Transfer/Move In
Last Grade Level Completed
Last School Year Completed
School ID
School Name
School Address
Semester
1st Sem
For Learners in Senior High School
2nd Sem
Track
Strand (if any)
Preferred Distance Learning Modality/ies
Modular (Print)
Online
Radio-based instruction
Modular (Digital)
Educational TV
Homeschooling
Blended
I hereby certify that the above information given are true and correct to the best of my
knowledge and I allow the Department of Education to use my child’s details to create and/or update
his/her learner profile in the Learner Information System. The information herein shall be treated as
confidential in compliance with the Data Privacy Act of 2012.
Signature Over Printed Name of Parent/Guardian
17
Date
CO_Q1_English5_Module1
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CO_Q1_English5_Module1
What I Know
What's In
1. cash deposit slip
2. withdrawal slip
3. school form
What's New
What's More
What I Can Do
Answer Key
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CO_Q1_English5_Module1
Additional
Activities
Assessment
*Answers will vary.
*Other required information
will vary.
References
"Student Asking Question Remix | Free SVG". 2020. Freesvg.Org.
https://freesvg.org/student-asking-question-remix. “Deposit slip”. In merriamwebster.com. Accessed May 27, 2020. https://www.merriamwebster.com/dictionary/%20slip.
“Fill out”. In oxfordlearnersdictionaries.com. Accessed May 28, 2020.
https://www.oxfordlearnersdictionaries.com/us/definition/american_english/fillout.
“Modified Basic Education Enrollment Form (BEEF) – LIS. Accessed on July 18,
2021. https://lis.deped.gov.ph
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CO_Q1_English5_Module1
For inquiries or feedback, please write or call:
Department of Education –Bureau of Learning Resources (DepEd-BLR)
Ground Floor, Bonifacio Bldg., DepEd Complex
Meralco Avenue, Pasig City, Philippines 1600
Telefax: (632) 8634-1072; 8634-1054; 8631-4985
Email Address: blr.lrqad@deped.gov.ph* blr.lrpd@deped.gov.ph